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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015600144
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:53:24 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2022 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20221104160953
FACILITY NAME:HODGES RESIDENTIAL FACILITYFACILITY NUMBER:
015600144
ADMINISTRATOR:HODGES, A., C., & T.FACILITY TYPE:
735
ADDRESS:3320 LOMA VISTA WAYTELEPHONE:
(510) 536-0998
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:6CENSUS: 5DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Demauriee Ingraham, Direct Supoort ProfessionalTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's are not allowed to leave the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/09/2022 at 11:00AM Licensing Program Analyst (LPA) K. Nguyen, arrived unannounced to conduct investigation on the above allegation. LPA met with Demauriee Ingraham, Direct Support Professional (DSP) staff and explained the purpose of the visit. LPA spoke with Anthony, Administrator (AD) over the phone to explain the purpose of the visit. AD gave verbal permission for DSP to sign the report.

It was alleged that Residents are not allowed to leave the facility. During the course of investigation, LPA interviewed S1, R1, R2, and R3 all states that they are allowed to leave the facility. R1, R2 and R3 states that they can leave the facility. Staff only advise them not to go out during mid-night or stay out too late because of safety purposes. LPA tour the facility was found that the facility and residents’ bedroom and observed that it was clean.

Unsubstantiated:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.
Exit interview conducted and a copy of the report is given to the Direct Support Professional.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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